People choose careers for a variety of reasons. For some, it’s to be part of a growing industry with an in-demand job. For others, it’s for a competitive salary, flexible hours, the option of working from home, or just one that is rewarding. Still, others want a career they can get into with just months of training rather than years. Becoming a medical coder or biller can give you a career that is all that and more.
They keep doctors and nurses on track and organized by compiling, processing, and maintaining patient records in a way that is consistent with healthcare system requirements. The role is vitally important to the healthcare industry as a liaison among medical providers, patients, and insurance companies. Many times, the titles (and duties) are intertwined, but each has specific duties.
The medical coder job requirements don’t involve patient treatment or diagnosis. However, he or she does need to have a basic understanding of anatomy, physiology, and pharmacology. Each diagnosis, treatment, or procedure has an assigned industry-standard code that the medical biller must accurately document in the patient’s health record. A medical biller, on the other hand, takes the coded information and uses it to submit claims to insurance companies so they can bill patients. If you work in a small office, you may be a medical coder/biller and do the job of both.
The codes are listed in the International Classification of Diseases (ICD), which is an organized way of telling a patient’s entire medical care story and his or her interaction with a doctor and/or hospital. The World Health Organization (WHO) created the ICD in 1948 as the gold standard for reporting diseases and medical conditions. The thousands of codes are globally recognized, so it’s easy to share and compare patient medical information among various hospitals, regions, and providers. They also ensure that the billed procedure is consistent with the patient’s diagnosis. For example, if you code conjunctivitis (“pink eye”) as a reason to request an x-ray, the claim would probably be rejected. A clerical error on the part of the medical coder—such as showing that a patient with a known allergy to penicillin received penicillin for an infection rather than another antibiotic—could result in serious harm to the patient.
In addition to ICD codes, a medical coder or biller needs to know CPT® (Current Procedural Terminology) coding. These five-character codes are the U.S. standard for the way healthcare professionals report and document medical, surgical, lab, radiology, anesthesiology, and E/M (evaluation and management) services. Some are fairly simple, but others go into more detail, so it’s critical that the coder pay attention to detail.
The coder looks at the patient’s chart to see the doctor’s notes, lab and radiology results and then assigns the ICD and/or CPT code that corresponds to the service performed, documenting it in the chart. The billing portion of the job may include the following tasks:
• Obtain referrals and pre-authorizations for required treatment procedures
• Verify insurance benefits and eligibility for treatments, hospitalization, and procedures
• Review patient bills for accuracy
• Use medical billing software to submit claims and bills
• Research and appeal denied claims
• Follow-up on unpaid claims
• Communicate with patients about billing issues or to set up payment plans
• Liaise with insurance companies
There are many personal skills you should possess if you want to do your job well:
• Attention to detail to enter the right code and check bills for accuracy
• Excellent communications to converse with insurance companies, patients and healthcare colleagues
• Good customer service to speak diplomatically and accurately to patients and insurance companies
• Accounting and bookkeeping basics to understand billing statements and reconcile them
• Computer ability to be able to use medical billing software
• Medical terminology to understand if a code seems incompatible with a diagnosis or treatment
• Problem-solving to handle discrepancies or inconsistencies in billing
• Teamwork ability to interact with other medical staff members
According to O*NETOnLine, the employment rate for medical records and health information technicians (billers and coders) is expecting to grow 11 percent through 2028, which is must faster than average for other occupations.
You must receive medical billing/coding training if you want to become a medical coder. Enroll in Coyne College medical billing and coding programs for an education that teaches you medical terminology, health records management, insurance procedures, billing software, and medical coding, as well as business communications and office administration. Your allied health training is 48 weeks of medical programs in Chicago that includes six weeks of electronic health records instruction—important in today’s real-world healthcare settings. Additionally, your hands-on training includes an externship that gives you the opportunity to learn in a professional setting in the Chicago area and helps you develop your skills and build self-confidence.
Contact Coyne College today to train as a medical billing and coding specialist. Classes begin September 28.